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Evaluation and Management Changes for 2021

Effective January 1, 2021, Evaluation & Management Codes will be changed for office visits only. The goals of this change are to:

  • Decrease administrative burden
  • Decrease the need for audits by expanding key definitions
  • Decrease unnecessary documentation

Medical decision making (MDM) or Time will be used to determine the level of E/M.

2021 Evaluation and Management Summary

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New Patient Visits

2021 CPT Code Code Description Medical Decision Making Total Time

99201

Deleted Code

Deleted

N/A

99202

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making.

When using time for code selection, 15–29 minutes of total time is spent on the date of the encounter.

Straightforward

15–29

99203

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making.

When using time for code selection, 30–44 minutes of total time is spent on the date of the encounter.

Low

30–44

99204

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making.

When using time for code selection, 45–59 minutes of total time is spent on the date of the encounter.

Moderate

45–59

99205

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making.

When using time for code selection, 60–74 minutes of total time is spent on the date of the encounter.
(For services 75 minutes or longer, see Prolonged Services 99XXX)

High

60–74

 

Established Patient Visits

2021 CPT Code Code Description Medical Decision Making Total Time

99211

Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal.

N/A

N/A

99212

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making.

When using time for code selection, 10–19 minutes of total time is spent on the date of the encounter.

Straightforward

10–19

99213

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making.

When using time for code selection, 20–29 minutes of total time is spent on the date of the encounter.

Low

20–29

99214

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making.

When using time for code selection, 30–39 minutes of total time is spent on the date of the encounter.

Moderate

30–39

99215

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making.

When using time for code selection, 40–54 minutes of total time is spent on the date of the encounter.
(For services 55 minutes or longer, see Prolonged Services 99XXX)

High 40–54

 

 

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